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NPI Code Detail

MEDICARE: DEAN A. DICKERSON, PH.D.

MEDICARE: DEAN A. DICKERSON, PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TP2701XGroup Psychotherapy PsychologistPSY6149CA

General Provider Information

NPI Number : 1720081367
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEAN A. DICKERSON, PH.D.
Provider Business Mailing Address
First Line : 1627 OAK AVE
Second Line : STE A
City : DAVIS
State : CA
Zip : 95616-1072
Country : US
Telephone Number : 530-756-0555
Fax Number : 530-756-1368
Provider Business Practice Location Address
First Line : 1627 OAK AVE
Second Line : STE A
City : DAVIS
State : CA
Zip : 95616-1072
Country : US
Telephone Number : 530-756-0555
Fax Number : 530-756-1368
Authorized Official
Title or Position : PSYCHOLOGIST/OWNER
Name : DR. DEAN AMES DICKERSON
Credential : PH.D.
Telephone Number : 530-756-0555
Provider Enumeration Date : 05/27/2005
Last Update Date : 06/24/2008

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